Ivette Vargas, Legitimizing Demon Diseases in Tibetan Medicine: The Conjoining of Religion, Medicine and Ecology. In Studies of Medical Pluralism in Tibetan History and Society. Proceedings of the Eleventh Seminar of the International Association for Tibetan Studies (Knigswinter, Germany 2006) Journal of the International Association of Tibetan Studies. Forthcoming in Brill Publications, 2009.

LEGITIMISING DEMON DISEASES IN TIBETAN MEDICINE: THE CONJOINING OF RELIGION, MEDICINE, AND ECOLOGYIVETTE VARGASThen again, Brahmin Rig pai ye shes thus spoke: Kye! Great Brahmin, listen! In the time of the last five hundred degenerate years, when the degenerate kalpa arises, human beings are in poverty as their provisions decline. Having plowed arid grassland for farming, sa nyan are turned up. Chu gnyan are disturbed by transforming natural water bodies into artificial garden lakes and ponds. Shing gnyan are deforested and rdo gnyan are uprooted or overturned. Contaminating hearth, burning impure substances, reckless slaughtering of animals in (spirit homes), and disturbing gnyan sa with the hope to subdue enemies by Buddhist and Bon priests who have no time to practice in the proper manner, all result in agitating ngas, gnyan and earth spirits, gods and rkasah. Poisons merely spread through touch, sight, breath and thought. The time comes for the rise of tsi ti dzva la [i.e. leprosy]. It is disgusting to see and fearful to think about. Merely hearing of these [illnesses] causes depression, vision of ones own corpse, and separation from loved ones.1

Ecology is the study of the relationship of the organism to its environment. The environment includes both physical properties, which can be described as the sum total of local abiotic and biotic factors that share a habitat. The above passage from the chapter on Gdug pa klui gdon nad gso ba2 in the Tibetan medical text Rgyud bzhi not only alludes to the well-known Buddhist notion of the degenerate age (the kaliyuga) when the Dharma is expected to be threatened,3 but it reflects a preoccupation with the relationship between nature and spirit entities whose balance may be tipped off in some negative direction due to ecological crises.4 As Tibetan medical texts as well as Buddhist and Bon po sources show, spirits known as klu (Skt. nga) are said to inhabit theChapter 81, Bdud rtsi snying po yan lag brgyad pa gsang ba man ngag gi rgyud. I am indebted to Amchi Thinley Gyatso, Phuntsok Gyaltsen, Vajra Acharya Chanzhi Decheng (Five Buddha Shrine, Nevada), Lama Karma Dorje (KSK TBC, Santa Fe), Sarah Harding (Naropa University), and Bhikshuni Ann McNeil (Thubten Norbu Ling, Santa Fe) for their assistance in the translation of chapter 81 of the Rgyud bzhi and/or related rituals for treatment. 2 Translated as The cure for the gdon disease of the harmful klu. 3 For studies on this issue, see Nattier 1991. 4 See some related ideas in Huber 1999.1

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physical environmenttrees, the underground, and water sources such as ponds and lakesand to affect both political and social worlds, in that they can protect and yet, be offended by human actions. What makes these figures particularly demonic is that, in possessing or attacking individuals, they cause diseases that affect our sensory perceptions, from our nervous systems (inflicting mdze, leprosy), our common sense (through smyo byed, insanity), and to our ability for spiritual advancement (as discussed in Buddhist and Bon traditions). As such, rituals to appease, transform or honour these figures for the health of individuals and to maintain order in Tibetan society has been prevalent for centuries.5 With the continuing secularisation and scientisation of Tibetan medicine in the Tibet Autonomous Region (TAR) of China and related changes in exiled Tibetan communities, a complex set of secular and religious concerns surrounding spirits traditionally known to be linked with the environment called klu and its disease-states has emerged. This paper focuses primarily on the role of the klu, with reference to the more general category of the nefarious spirit, gdon, in the Tibetan medical tradition. I am concerned with how diagnosis and treatment of these spirit-borne illnesses traverse the tenuous relationship between religion, politics, and medicine in the modern context. Whator who exactly are these entities called klu? What is their relevance in Tibetan medical texts? Why are illnesses related to these entities still significant categories today for treatment purposes? Do beliefs in these entities reflect a preoccupation about the ecological and medical crisis in modern Tibetan society in the TAR? If so, what is the significance of klu and klu nad in exile? Preliminary textual work and ethnographic research with Tibetan physicians from the US, Tibet, and Dharamsala, India during 2004-07 reveal a complex interaction between medical and religious communities. This essay discusses this relationship in three ways: first, I present a study of the representations of klu in religious and medical texts; second, I discuss the distinct understandings of klu in current Tibetan medical practices; and third, I consider the klu in connection with the interweaving of tradition and modernity in current Tibetan medical institutions. This paper hopes to show that, for their positive and negative aspects, klu form the embedded ecology of everyday Tibetan life.6 Such5 6

See the classic study by De Nebesky-Wojkowitz 1993; Vargas 2003. Nagarajan 2001:453-68.

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a study also resonates with current concerns about the impact of development and modernity on Tibetan cultural regions.7 Klu in Religious Texts What does klu signify? This is, of course, a very complex question often dependent on religious and historical contexts. What is consistent in the textual evidence is that klu are considered one of the most ambivalent figures to appear throughout Asian literature. Closely linked with the environment, monastic, royal, and political institutions, and the wellbeing of individuals, klu as wrathful and protective deities, have often been at the center of religious practices. They were, on the one hand, the Buddhas staunchest adversaries, and on the other, guardians of the dharmaonce they were pacified.8 Klu have been prevalent in Tibetan religious traditions prior to the advent of Buddhism and throughout its transmissions. Klu were identified with the well-known ngas from the Indian context perhaps around the time of the 8th century as indicated in the Abhidharmakoa.9 In the Chinese context, klu is often equated with the dragon, klung. Klu can be classified in a number of ways depending on the text. As Katsumi Mimaki and Samten Karmay make note, in Bon po texts like Bon sgo gsal byed, Gzer mig, and others, klu are classified as both lha ma yin (Skt. asura) and yi dwags (Skt. preta), while in Buddhist texts like the Abhidharmakoa-bhya, the two categories of klu (nga) such as nga rjas (ngdhipati, klu bdag) and ordinary ngas (klu phal pai ming la) are classified differently. The first are considered animals (dud gro) because of their serpent-like form and their apparitional birth (like the garuda and the kinnara), while the second are considered pretas.10 InNote publications like Apte and Edwards 2004, Sautman and Dreyer 2006. In Indian mythology, nga (Tibetan, klu) are the serpent spirits who inhabit what could be labelled as the underworld, or water sources like lakes, rivers, ponds, and trees. In many respects, the Buddhist nga inherited much of the early Indian Hindu symbolism. In Buddhist cosmology, they are assigned to the lowest level of Mt Meru with their garuda (mythical birds) enemies on the level above. See Cohen 1998:360-400. 9 I thank Geoffrey Samuel for information on this. 10 Katsumi Mimaki points out that these entities exhibit hallucinations, fear and other negative emotions (aggression, anger), and inflict disease and poison. In such Bon po texts, these preta-klu move through space (mkha la rgyu ba) and inhabit the underworld (gnas na dug pa) accompanied by snakes or water sources (described as chu bdag klu). Pretas (like other beings as tsen, gyelpo, shindre, jungpo, mamo, theurang, etc.) in8 7

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Rne de Nebesky-Wojkowitzs classic study of Bon po and Buddhist texts, Oracles and Demons of Tibet, klu may fall under the categories of dregs pa (lower ranking spirit), dgra lha (literally, enemy god, also a protector spirit), or as potentially harmful retinue for mgon po (protective deity).11 Klu can also join with other spirits and take on new characteristics.12 How they appear and where they dwell can also vary textually and iconographically. These theriomorphic snake-human or completely snake-like entities are often believed to embody the forces of nature like trees and water sources as well as possess humans bodies, or even control an entire society. Cosmologically, they may dwell in the region below according to a belief in a tri-partite division of sky, intermediate space, and lower region, and specific directions like the West.13 How klu are conceived doctrinally and philosophically is especially telling for this study. In terms of spiritual attainment in Buddhist texts, klu play a dual role, protecting as well as obstructing practice. According to the Buddhist tradition, the klu as nga are known to have protected the Mahyna teachings prior to being retrieved by Nagarjuna. In the rnam thars of Dge slong ma Dpal mo, an 11th-century Kashmiri Buddhist nun, klu obstructed her development as a practitioner and even led to her contraction of leprosy. After this, Dge slong ma Dpal mo is healed, she transforms the klu into Dharma Protectors of Ekdaamukha Avalokitevara:In the saga month [at the time of the constellation] sa ri nam mthongs, the interfering demons were placed in the state of bodhicitta. [Nun Palmos] illness, sins, and defilements were purified

Buddhist texts live their lives in constant terror and hallucination, often afflicted by diseases. As animals according to the Buddhist tradition, klu are constantly tortured by garuda (khyung) and garuda keep them in their beaks symbolising the negative emotions. As asuras, the Bonpo text indicates that klu fall under one of the three classes, one of the 11 che ba who are g.yen of the ground. In Buddhist cosmology, asuras live in constant quarrel and aggression, full of envy toward the gods whose desires are completely taken care of. See Mimaki 2000:99-101; Mimaki and Karmay 1997. 11 de Nebesky-Wojkowitz 1996:49, 253-254, 324. 12 For example, klu bdud. Ibid:285. 13 Ibid:292. Joseph F. Rocks classic study of the ngas in the Naxi tradition, a Tibetan cultural group that follows Bon po, Chinese Daoist and indigenous beliefs, goes into detail on where these spirits dwell and what they cause (Rock 1952).

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and she saw the truth of the first bhumi. On the first day of sa ga zla ba, she witnessed the countenance of the Holy Tr and [Tr] prophesised, Buddha activities of all the Buddhas of the three times are consolidated in you. On the eighth day, she witnessed the majority of the kriy tantra deities such as five Amoghapaa deities and so forth. On the fifteenth day, she witnessed the countenance of the Eleven-faced One endowed with a thousand hands and a thousand eyes and furthermore, countless Buddhas in all the pores of the body, the hands also being the quintessence of Buddhahood. On the eyes on the palms of the hands, she witnessed a host of tantric deities. Since the holy one talked about the Dharma, inconceivable samdhi arose in [her]. She saw the truth of the eighth bhumi. Then moreover she practiced the fasting ritual for three months more for the sake of all sentient beings.

These figures are therefore considered real entities that appear to obstruct practice and biological functions because of karma, or some other offense and general lack of reverence. They are, however, also conceived of as psychological entities in the Buddhist sense, that is, as mental projections based on ones deluded view of reality. Klu in Tibetan Medical Texts According to Tibetan medical texts, the body is a complex entity comprised of empirical and spiritual14 physiology. The pathogens that cause disease also derive from a variety of sources, and the treatment requires somatic, psychiatric and religious approaches. 15 In the Four Tantras, the descriptions of illnesses caused by klu reflect a number of textual sources, one significantly being the well-known Sanskrit medical treatise on yurveda, the Angahdayasahit of Vgbhaa, as well as others that seem to have arisen from Tibetan14 I am using this term to refer to a religious conception of physiology. This would include spirits such as klu. 15 Despite its shortcomings, Terry Cliffords work is one of the few studies on this subject, Clifford 1990.

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sources.16 Spirits known as kun brtags gdon (that include klu) are recognised as one of the primary causes of disease alongside karma, seasonal changes, habits and behavior, and poisons. In medical texts like the 12th-century Four Tantras, klu are subsumed under the larger category of bgegs, literally obstacles. The traditional Buddhist enumeration of 84,000 bgegs in the sutras correspond to the 84,000 mental defilements. Out of the bgegs arise the complex category of gdon.17 Gdon include a pantheon of figures like asuras, pretas, gandarvas, rkasah or others known as the eight classes (lha srin sde brgyad) that includes klu, sa bdag, rgyal po, bdud, mamo, yaksha, lha, and other entities emergent from Bon and Buddhist traditions.18 In the third and longest volume of the Four Tantras, the Instructional Tantra (Man ngag rgyud), five chapters (7781) focus primarily on gdon nad (illnesses caused by spirits), although these diseases are also referenced in other chapters as well. The diseases are grouped according to five gdon: byung poi gdon, smyo byed kyi gdon, brjed 19 byed kyi gdon, gza yi gdon, and klui gdon, each related to different areas of the environment and body.20 Chapter 81 is specifically about klu although they appear in relation to the other gdon as well. As in religious texts, klu in these medical sources retain their theriomorphic and other forms as described earlier.21 The klui gdon inflict harmful effects on individuals, especially when offended, in the form of a kind of sgrib (meaning pollution or defilement). In the Four Tantras, klui gdon nad is described as an illness that manifests as klu possessing, attacking, or inhabiting a human being. Past karmic relations and low accumulation of virtuous actions especially in relation to the environment, in addition to bad diet that affects the nyes pa (faults or humors that form the three principles of physiologic16 I thank Geoffrey Samuel for directing me to the sources here. For recent studies of Tibetan medical histories, see Garrett 2007, 2008. 17 Although according to Tibetan dictionaries, the nominal form is taken to mean evil spirits or demons, the term itself literally derives from the future tense of the verb don meaning to cause to come out or come forth, to drive forth. Jaschke 1995: 267. 18 Samuel 1993:161-163. 19 For studies on epilepsy, see Emmerick 1987:63-90. 20 Gdon of elements, insanity, epilepsy, planets and serpent. Bdud rtsi snying po yan lag brgyud pa gsang ba man ngag gi rgyud 1993: 384-387, 387-388, 388-389, 389-392, 392-401. 21 See Clifford 1990: 177 for some descriptions.

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regulation, rlung, mkhris pa, bad kan), provide klu an opportunity to inflict mental and physical harm. These demons make people operate in an extreme way in the world of the senses, described with reference to the standard Buddhist mental obscurations (kleshas, nyong mongs). Note again the passage from chapter 81 quoted earlier:Having plowed arid grassland for farming, sa nyan are turned up. Chu gnyan are disturbed by transforming natural water bodies into artificial garden lakes and ponds. Shing gnyan are deforested and rdo gnyan are uprooted or overturned. Contaminating hearth, burning impure substances, reckless slaughtering of animals in (spirit homes), and disturbing gnyan sa with the hope to subdue enemies by Buddhist and Bon priests who have no time to practice in the proper manner, all result in agitating ngas, gnyan and earth spirits, gods and rkasah. Poisons merely spread through touch, sight, breath and thought. The time comes for the rise of tsi ti dzva la [i.e. leprosy].22

With the disruption of the land, water, trees and the performance of improper ritual behavior, the environment (in the form of spirits), responds on a physiological-mental level with the infliction of leprosy. Chapter 81 describes 18 different locations for the 18 (or 36 if you sum up the sites) types of klui gdon nad from the skin to other parts of the body including the muscles, fat, ligaments, blood, bone, brain, semen and internal organs.23 It also gives us a detailed list of the symptoms of klu disease including complexion problems, nose bleeds, fluctuating body temperature, pustules (shu thor), blisters (chu bur), various discomforts and wounds, variations in voice, and psychological problems.24 Because these entities have an undisciplined nature, they manifest in exaggerated ways in the individual: increasing mental obscurations to a near frenzy and blocking sensations altogether as with neuropathies, rashes, and leprosy. The onset of klui gdon nad is often preceded by a dream of a bull or some other animal ready to attack, indicating an offence has been committed against a klu. As in the case of Kayapas story in the yurvedic tradition, the actions of individuals cause openings for demons to enter into vital points in the body that eventually afflict the mind and consciousness.25 As Dominik Wujastyk notes in his study ofBdud rtsi snying po yan lag brgyad pa gsang ba man ngag gi rgyud 1993[1982]: 392-393. 23 Bdud rtsi 1996:393. 24 Bdud rsti 1996:393-401. 25 Wujastyk 2003:210-238.22

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malevolent spirits in yurvedic texts, demons have the capacity to be vengeful, imposing, as he says, a medical punishment on the individual.26

Treatment is very diverse for this disease but what is key is that it is a three step process: protection from obstacles, curing the disease, and lengthening life.27 What is therefore required is to treat the klu first (since it is klu that is ill), and then to treat the patient. Treating the klu and then the patient requires both ritual and medicine, utilising rituals that protect one from the klu (by subjugating them) and cleansing ones negative karma; developing bodhicitta for the gdon of klu; ingesting various plants, precious stones, garuda pills (garuda is the natural enemy of the klu/ nga), and undertaking a healing bath (lum pa).28 Klu and klui gdon nad in Modern-day Tibet and India But what relevance does klu and its diseases have in the modern context? From the perspective of modern Tibetan medical practice, klu plays a complex role. This paper further examines how klu reveals some of the challenges faced by Tibetans in modernity. As Arthur Kleinman has often noted, disease reveals underlying social and cultural constructs and tensions.29 The occurrence of disease also reveals a cultures urgency to retain some semblance of its so-called traditional identity amidst political and economic pressures. There are many times in Tibetan history that point to this. One is the case of a smallpox epidemic during the imperial period in Tibet, when Buddhism was accused of bringing the curse of the disease upon the Tibetan royal court. Matthew Kapstein draws attention to an outbreak of illness in the eighth century:At about the time [during the events in Khotan described earlier in the text] the divine Tsenpo of Tibet and the lord of China formed [the relationship of] nephew and uncle, at which the Chinese princess, too, became the divine Tsenpos bride. The Chinese princess builds one great temple in Tibet and established the provisions. The whole sagha went there, whereupon the princess also provided rations. The doctrine of the Mahyna having thus blossomed in Tibet, for a period of 12 years both the sagha and ordinary layfolk practiced the doctrine and so were

Wujastyk 1999:256. Bdud rtsi 1996:394-401. 28 Ibid. 29 Kleinman 1980.27

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exceedingly happy. But even there Mras host became agitated, and Mra sent forth the black pox and many other sorts of disease. As for the princess, she died after the black pox appeared at her heart. After that the laity lost faith and said that the occurrence of the black pox and many sorts of disease was an evil due to an arrival in Tibet of the host of the sagha. It was ordained that not even one member of the sagha be permitted to remain in Tibet. After they were banished, one and all, the entire sagha traveled to Gandhra in India .30

Ethnographic fieldwork and interviews with physicians, instructors at medical schools, administrators, and lamas in Lhasa, Tibet, and Dharamsala, India, reveal a diversity of opinions about klui gdon nad, and these reflect Tibetan discourse on traditional religious and medical beliefs. In the modern context, the diagnosis of diseases as caused by demons in the TAR and other areas of China still remain, despite an increasingly secularised and/or biomedical Tibetan perspective, particularly with reference to treatment, and an increasingly specialised medical profession. Both Vincanne Adams (2001) and Craig Janes (2002) provide a framework from which to understand the elements of secularisation and scientisation in Tibetan medical training and practice in Lhasa, Tibet. Janes (2002) draws attention to the increasing globalisation, and thus homogenisation, of Tibetan medicine through the mechanisms of the Chinese state and the governments concern for increasing market capitalism. The secularisation and scientisation of Tibetan medicine at the Tibetan Medical College in Lhasa and the Mentsikhang are evident through descriptions I recorded of klu diseases (and its relation to klus empirical and metaphorical nature). As Foucaults (1980; 1995) work on the dynamics of discourse and power in the representation of social reality make clear, it is instrumental to unveil the mechanisms by which a certain order of discourse produces permissible modes of being and thinking while disqualifying and even making others impossible. For example, training at the medical college is focused on being scientific and secular in its theoretical and practical content. At the medical college, students are taught that klu and gdon either do not really exist or are mental projections of some kind (instead of focusing on what the historical medical texts state and/or exploring their underlying religious ideas). In terms of treatment, students learn that gdon and klu diseases must be treated physiologically, and not spiritually. This means30

Kapstein 2000:41-42.

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that they learn how to prescribe certain medicines for observable symptoms and make dietary recommendations, and do not engage in meditative or ritual practices. Such conditions are considered diseases that do not concern religion. As such, this contemporary treatment of klui gdon nad contrasts with traditional understandings of treating klu diseases as discussed in the Four Tantras (and even Bon po texts like the Klu bum and the rnam thars of Dge slong ma Dpal mo), which require treatment of the klu first and then the patient. Thus, there is a major disjuncture between what is taught at the Lhasa medical college today and what is stated in Tibetan medical texts. Informants in Lhasa indicated that medical students tackle these conflicting ideas about klui gdon nad in their training in several ways. Sometimes students and instructors discuss these diseases using different terms, for instance substituting mdze nad (leprosy) instead of klui gdon nad avoiding the terms for these entities altogether. In addition, they also refer to these diseases as environmental diseases, but not in the sense that environment is conceptualised in Tibetan medical and religious texts.31 In these contemporary milieu, the environment is secularised. As an administrator at the college noted, young Tibetan medical students take pride in thinking that they have inherited an environmentalist tradition, a long history of concern about nature.32 This view, however, in terms of disease causation, is not taken further to the realm of the spiritual, to the non-human realm of the hindering spirits of the environment who get offended and inflict disease.33 With the conscious effort made to separate religious from secular discourse in medical training, the environment is conceptualised without the somatic element (that is, not linked with the human body). Thus medical students come out with a superficial sense of their environment and an understanding of klu and gdon nadat least according to literary Four Tantras standards and historical cultural views. In contrast, there were, however, several informants at the medical school who noted that it was not harmony with the environment but harmony with the non-human that we should foster.34 This sentiment could not be openly discussed in the current political climate.I thank Dr Tashi, Dr Namgyal, and others (I am unable to reveal identities) for this remark. 32 I thank one of the administrators at the college for this idea. 33 Same administrator noted above. 34 Administrator Thubten noted September 15, 2006.31

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The conscious effort to secularise or appear so was also evident in the reticence to talk about klui gdon nad on the part of some administrators, medical college professors, Tibetan physicians. The disease was described as a spiritual disease, and that, as several informants succinctly put it, The Chinese government separated religion from medicine. Often, questions about klu or gdon had to be phrased as medical questions. For example, I had to say I was discussing medical treatment or diagnosis when interviewing Mentsikhang physicians whenever an hospital administrator came around and not that I was asking about religious interpretations. Although texts on such subjects as gdon nad gso ba were given to me by professors and were available at the local bookstore in the Lhasa Barkhor marketplace, the content and treatment of such diseases were not easily discussed in public. At the Mentsikhang, however there were two main responses to questions regarding klui gdon nad. In addition to the reticence already encountered with medical college professors and administrators, there was also a much more flexible attitude toward diagnosis and treatment within limits, where religion was allowed. For example, two physicians in two specialisations unrelated to gdon nad were said to be experts in diagnosing and providing some treatment to patients with this disease. In addition, some physicians even fostered a relationship with the Klu khang, a temple located behind the Potala Palace. Physicians not only treated patients with suspected klui gdon diseases with conventional Tibetan and biomedicine, but they also referred patients to the local lama for further spiritual treatment, i.e. mantra recitation, prayers, and offerings. If patients exhibited mental disturbances, they were also immediately sent to a lama.35Tibetan temples like the klu khang (short for Rdzong rgyab klui pho drang, meaning the water spirit house behind the fortress) in Lhasa are a reminder of the relationship between the religious and medical institutions forged by the klu. This structure was built around the time of the sixth Dalai Lama (Tshangs dbyangs rgya mtsho, 1683-1706?) in order to appease and honour klu because of their potential to create calamity. Klu images abound in this temple, mostly half human and half serpent, one has a serpent head and lower body with a human chest and arms. The two lower floors are dedicated to the klu. Some areas depict ngarjas with a retinue of ngas, others are holding jewels or other offerings, and scepters, mostly emerging or immersed in water, on some pedestal or small temple. The ground floor enshrines a gold-plated image of Ngarja Maldrozichen, whose female partner, klu mo, was said to have visited the Fifth Dalai Lama during his meditations. The floor above houses a large gilded statue35

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According to fieldwork observations at the Klu khang in 2005, numerous patients and others exhibiting symptoms and dream experiences associated with klui gdon nad were found requesting prayers from the temples lamas and making offerings. Not only was the Klu khang a site of healing or complementary treatment, it also represented a continuity of tradition surrounding beliefs regarding the klu. Ian Baker (2000) notes in his work on the Klu khang that farmers still bring segments of their fields to the shores of the lake behind it in hopes of ensuring good crops (as mentioned earlier, klu are known to bring wealth).36 This behavior is consistent with Tibetan action and activity from before the Chinese annexation of Tibet in the 1950s. Both the actions of physicians referring patients to the Klu khang and the farmers visits, represent a continuity of traditional beliefs about the klus connection to the environment, broadly conceived. Overall, what is evident here is not just the issue of secularisation on the Tibetan medical level, but an increased specialisation and professionalisation of previously overlapping domains of ritual healing and more strictly medical healing. Thus there are pervasive distinctions in domains of healing or a division of labor in terms of treatment. Reminiscent of the work of Ming-Cheng M. Lo (2002) who studied the case of Taiwanese doctors in colonial Taiwan, political policies led to interactions between the processes of professionalisation and colonisation.37 In addition, what may be called on the surface a pluralistic or complementary medical approach in terms of klu on the part of some physicians should not come as a surprise in spite of the restrictions concerning religion since beliefs in klu seem to still permeate Tibetan culture. On another note, the religious avenue appears to be still an option since Western biomedical resources like psychological or psychiatric treatment that could be utilised for some klui gdon nad

of Ngendrarja, the form taken by the historical Buddha to tame the Ngas realm. The surrounding walls of the middle floor depict episodes of Pema Obar, where an earlier form of Padmasambhava reclaims the wish-fulfilling jewel from the Ngarja. There are three images of Padmasambhava on the East wall of the top floor that depicts him subduing the ngas. See Winkler 2002:321-344. I made observations of the murals during a 2005 visit. 36 Baker 2000:14. 37 Lo 2002:7.

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symptoms are not widely accepted or readily available in the Tibetan context. Results collected among Tibetan physicians and administrators in exile communities in Dharamsala, India, indicate some contrasting findings. Some physicians indicated that gdon diseases are one of the most common ailments among the Tibetan community. This indicates that there must be several offences committed against them. As a result, lamas in charge of rituals to subdue them are common. One of the physicians at the Men-tsee-khang gave two anecdotal accounts of human actions that offended klu. The first story went as follows: A distant friend of one doctor accidentally drove over and killed a snake. Afterwards he fell unconscious, and at times, could not think straight. He had weird feelings. He was advised to go to a high lama who could perform a divination. When he explained his problem to the lama, the lama told him to build a stupa with incense inside, which he did. After this, he felt better. The second story related to a classmate of this doctor who had been getting rashes in the lower part of his body (the part of the body that is commonly affected by klu). He went to a lama who blessed some butter with a mantra, applied the butter to his rash, and performed divinations. The rashes disappeared after a few days.38 Other Tibetan physicians and administrators, however, either denied the existence of klu or klui gdon nad altogether drawing from a more secular perspective or believed staunchly in their existence reflecting either Buddhist philosophical conceptions of perception and the environment. Reminiscent of what occurred in the TAR in a climate of secularisation and scientisation of Tibetan medical training, a doctor from Delek Hospital gave a more psychological answer that klu nad and gdon nad are common where people believe they exist and that they can be harmed by them.39 The focus here is on belief and not necessarily on concrete fact. Dr Tsering Dorjee Dekhang from the Men-tsee-khang on the other hand, indicated that it is not common because klu are perceived only through proper training of our mind or higher re[a]lisation as Buddhist teachings indicate.40 Another person indicated that because of Indian government38 39

Stories collected during summer 2006. Dr Tsetan Sadutshang, Delek Hospital, Dharamsala, India, August 17, 2006. 40 Dr Tsering Dorjee Dekhang, August 15, 2006.

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laws on deforestation, environmentalist movements, and better sanitation, klui gdon nad is not as common among Tibetans in India than in Tibet.41 Finally, Dr Tsering Dorjee Dekhang noted that klu diseases are not spiritual but known to be caused by spirits. The spirit sort of attacks the person by mental power and can do this more easily to a person who has accumulated less merit. For him, a person who is more fearful is more likely to get attacked by klu than a person who is more confident. The distinction between spiritual and spirit mentioned above is crucial since it contrasts critically with ideas expressed in Lhasa. Unlike Tibetan medical students in Lhasa who focused on the secular dimensions by explaining the appearance of klu in texts as an example of the Tibetan cultural heritage of environmentalism and many denied any factual existence to these entities, this physician in Dharamsala on the other hand, focused on the reality of the entity as an agent of disease. In addition, his descriptions reflect a tradition in which there is an overlap of ritual and medical healing, often deriving from the same person unlike the increasing specialisation and professionalisation (and thus division of labor) that was evident in Lhasa. There was also evidence of a certain hierarchy of resort in treatment (since not all physicians were equipped to diagnose or treat such diseases) and agency on the part of patients. In terms of treatment, Lobsang Norbu Gyalnang of the Astrology Department at the Men-tsee-khang noted that there were no special doctors to treat these diseases so patients go to different physicians until one diagnoses them with a klu disease. As described in the Four Tantras, the system of treatment was followed in a similar way. Dr Tsewang Tamdin, the Deputy Director of the Men-tsee-khang noted that, in most cases, rituals are performed first and thereafter medicines are prescribed for patients afflicted by klu. Unlike the Lhasa case, there is an overlapping of domains of healing, medical and religious: We have doctors who are also practi[c]ing tantric rituals for klu nad, he explained.42 Dr Tsewang indicated that rituals employed include klu gtor, klu bsangs, klu cho, men ngak lhan thab and

Dr Dawa Dolma, Men-tsee-khang, July 24, 2006. Dr Tsewang Tamdin, Deputy Director, Mentsikhang, Dharamsala, India, August 10, 2006.42

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the klu bum dkar nag khra gsu.43 as well as prayers like klu spangs kong.44 Rlung rta rituals are also common.45 However, perhaps due to increasing specialisation on the part of Men-tsee-khang physicians, there are instances that doctors and lamas work together in terms of treatment. Another example of this system of treating the klu first and the patient second is reflected in yet another physicians comments, but here by contrast, Western treatment is used alongside Tibetan treatment in terms of medical options: Tibetan doctors would not refer a klu patient to a Western treatment unless you find a strong infection. We would sen[d] him to a reknown[ed] powerful lama for the klu treatment first and then to [sic] Western treatment if it is an infection, and would treat [him] oursel[ves] if it is treatable with our medicine.46 As Dr Tsetan Sadutshang of Delek Hospital noted, Doctors [of ] (Western medicine) treat these according to a conventional diagnosis (e.g. leg ulcer), traditional medicine treats the imbalance of humours. The mainstay of treatment is not medical, it is spiritual, i.e. appeasing the spirit and doing puja, rituals.47 This of course is a different interpretation of the use of the word spiritual than we have encountered before, taken out of the purely intellectual metaphorical level to a much more literal of the word meaning of consisting of spirits. This access to diverse medical options reflects medical pluralism in India: exiled Tibetans have access to a vast variety of medical systems and treatments.48 Overall, based on the observations made in the TAR and in Dharamsala, I argue that klui gdon nad diagnoses and treatments maintain traditional associations between medical and religious institutions. They also promote an awareness of the religious dimensions of the environment and accentuate concerns about Tibetan identity. ConclusionsRediscovered by Gshen chen klu dga, this is a text that recounts Gshen rab mi bo ches encounters with the klu and describes the ritual methods of subduing them (Kvaerne 1974:43,102). 44 Lobsang Norbu Gyalnang and Dr Dawa Dolma, August 2006. 45 Klu rituals during special nga days, particularly Mondays and Wednesdays, are performed to honour and appease the klu and keep then in check. 46 Dawa Dolma, Men-tsee-khang, Dharamsala, India, August 15, 2006. 47 Dr Tsetan Sadutshang, Delek Hospital, Dharamsala, India, August 17, 2006. 48 Such studies include Leslie 1980, Obeyesekere 1989, Nichter 1981, Langford 1995, Samuel 2001, and others.43

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By way of conclusion, I would like to resurrect some of Helmut Hoffmans characterisations of Bon as a religion totally dependent on the natural environment. For Hoffman,The Tibetanswere apparently completely subject to the powerful and formidable nature of their natural surroundings. Their completely nature-rooted and naturedominated religious ideas revolved reverently and submissively around the powers and forces of their wild highland landscape whose divinities were reflected in the idea of numerous good and evil spirits the Tibetans thought to see around them.49

Although Hoffmans characterisations had their flaws following natureromantic ideas current in Europe since the 19th century, as well as outdated modes of thinking in anthropology and the study of religion, they do resonate on a general level with underlying contemporary Tibetan cultural concerns. As Ian Baker in his work on the Klu khang has noted, [N]agas are viewed as literal entities or as potent icons of an ancient covenant with the Tibetan landscape.50 This study points in the direction of further investigation of these interpretations. This study of klu as well reminds us of the Tibetan religious and medical associations with its natural environment. The interest of klu in medical texts and current Tibetan medical practices helps us think about the complex threads of perspectives and challenges faced by practitioners of Tibetan medicine in coming terms with their religious heritage and the need to recognise themselves as modern (or secular) or traditional. In addition, in my attempt to understand the role of klui gdon nad in modern Tibetan medicine and culture, I see that it is a condition that creates interaction between worldviewsthe religious, the medical, and the political or social. As in Indian literature, klu are involved in and represent the social dynamics of a culture, the diversity of religious beliefs, the rituals that represent and bind those beliefs, the political bounds of particular periods, and the ambivalent (and at times, the tempestuous) relationship of a culture with its environment. My study, however, also problematises these areas of interaction, klu represent underlying tensions, accommodations, transformations, and realisations of spiritual attainments and medical practicalities.51 The interactions of medical49 50

Hoffman 1961:17. Baker 2000: 26. 51 Although we do not see a blatant equivalent of what Mark Nichter noted in India in terms of image[s] of sages adorn[ing] medicine bottles with English names promising

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theories, religion, politics, and the environment as a whole creates a dilemma in modern medical practice both in the TAR and in Dharamsala, where politics, modernisation, and Westernisation are dictating what is learned and what is practiced, if for different reasons. This study also draws attention to much broader issues of modernity and agency. As Ming-Cheng M. Lo (2002) notes in her work on colonial Taiwan and medicine, modernity cannot exist outside of the culturally specific plans of its deliverers and the culturally specific evaluations of its receivers (Lo 2002:1-24, 181-200). Thus there is no modernity that is not localised or part of a non-relational process. With increasing ecological and cultural crises caused by development projects in both India and Tibet, klu, I must say, are still causing some havoc.52 Acknowledgments I am grateful to physicians at the Tibetan Medical College and the Mentsikhang in Lhasa, Tibet and in Dharamsala, India; and those residing in the US for their time and assistance. I also thank Drs Eric Jacobson, Vincanne Adams, Linda Barnes and Sienna Craig for their medical anthropological perspectives. Geoffrey Samuel has been helpful in helping me reflect on the interface among religion, health and demons historically in the Tibetan contexts. I thank Ngawang Jorden for his assistance when I needed it. My student Janice Dean has been helpful with some of the interviews with Tibetan physicians in Dharamsala, India and contacting informants during her Lilly research trip in summer 2006 and in Lijiang, China under the Mellon Collaborative Faculty-Student Research Grant in 2007. Ethnographic work in Lhasa, Tibet in 2005 was made possible through a generous grant from the Wabash Center for Teaching and Learning. I also thank my student Devin Gonier. Textual and fieldwork in 2004-07 was also supported by Austin College Richardson Funding.

relief from the ills of modernity, the presence of klu reminds me of the concerns in present-day Tibetan communities (Nichter 2001:104). 52 Although beyond the scope of this paper, during my research I encountered concerns about the inadequate treatment of increasing infectious diseases such as AIDS and HIV and the impending development projects.

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